Illustrations

Whipple procedure

General

A Whipple procedure is performed when there is suspicion of a malignant tumor in the head of the pancreas or adjacent organs such as the duodenum or bile ducts. The operation is also carried out for some cases of chronic pancreatitis.

A Whipple procedure is not performed if there is spreading of cancer to other organs or to peripheral lymph nodes. Invasion of blood vessels (especially the mesenteric artery and greater mesenteric vein) is also a contraindication. In some cases of limited vessel invasion, the operation can still be carried out in combination with vascular surgery.

The head of the pancreas is removed. Since the pancreas shares blood supply and lymphatic drainage with adjacent organs, some of the common bile duct is removed along with the entire duodenum and often the distal stomach . Finally, a reconstruction is performed where the small intestine is anastomosed to the remaining bile ducts, stomach, and remaining pancreas.

Mortality of the procedure is low, but postoperative morbidity is still significant. To reduce postoperative mortality, the patient should be operated at a hospital with a large volume of operations and after critical preoperative assessment of the patients.